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Pharm Exam 3 > Neoplasm 1 > Flashcards

Neoplasm 1 Flashcards

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1
Q

Carcinoma

A

begins in the skin or in tissues that line or cover internal organs.

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2
Q

Sarcoma

A

begins in bone, cartilage, fat, muscle, blood vessels, or other connective/supportive tissue.

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3
Q

Leukemia

A

starts in blood-forming tissue (bone marrow); causes large numbers of abnormal blood cells to be produced and enter the blood.

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4
Q

Lymphoma and multiple myeloma

A

begin in the cells of the immune system.

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5
Q

What is the MC type of CA in the US?

A

Skin

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6
Q

What is the MC CA to cause death in the US?

A

Lungs

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7
Q

Lung CA can be classified into?

A

small cell lung cancer or non-small cell lung cancer

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8
Q

What causes colorectal CA to arise?

A

Adenomatous polyps

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9
Q

Where do malignancies occur in breast CA?

A

Arises from malignant transformation of the epithelial cells lining the ducts and lobules of the breast

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10
Q

Problems that arise w/ use of chemotherapeutic drugs?

A

Emergence of resistant organisms and cells
Adverse effects they can cause to the host

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11
Q

Which areas of the body are susceptible to SE caused by chemotherapeutic drugs?

A

common side effects in hematological, GI, integumentary systems

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12
Q

How are cytotoxic meds prescribed?

A

Protocols:
Dosing by body surface area
Dosing in cycles
Grouping similar cytotoxic agents together in categories
Understanding of the cell kill theory to determine treatment length

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13
Q

What is used to calculate dosing of cytotoxic drugs and why?

A

BSA - its less affected by adipose mass than weight; therefore a better indicator of the patient’s metabolic mass

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14
Q

What are cytotoxic cycles?

A

Ways to administer cytotoxic meds in cycles. Some are given over a short period of time, others over several hrs. Cycles are given every 1, 2, 3, or 4 wks.

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15
Q

What is cell kill theory?

A

Proposes that a set percentage of cells are killed with each dose of chemotherapy
When only a few cancer cells remain, it is hoped that the body’s immune response system will take over and kill the final few cells

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16
Q

What are the phases of the cell cycle?

A

Phase I: Resting Phase (G-O)
Phase II: Post-mitotic Phase (G-1)
Phase III: Synthesis (S)
Phase IV: Premitotic Phase (G-2)
Phase V: Mitosis (M)

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17
Q

Why does CA occur in cells?

A

Cancer cells enter the cell cycle independently of the body’s feedback system
Deregulation of cell-cycle control proteins plays a key role in the development of cancer

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18
Q

Cell cycle time

A

the amount of time required for a cell to move from one mitotic phase or cell division to another

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19
Q

Growth fraction

A

refers to the percentage of cells actively dividing at a given point in time

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20
Q

Tumors with a greater fraction of cells in G-0 are more sensitive to which type of agents?

A

cycle-nonspecific agents

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21
Q

A higher growth fraction causes what?

A

more cancer cells to be killed when they are exposed to cell cycle-specific drugs

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22
Q

Tumor burden

A

the number of cancer cells present in the tumor

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23
Q

Cancers to small tumor burden are more sensitive to what?

A

cytotoxic therapy because they have a high number of cells reproducing

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24
Q

Cell cycle–specific (CCS) drugs

A

agents that exert their cytotoxic activity during a particular phase of cell division cycle

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25
Cell cycle non-specific (CCNS) drugs
agents that have cytotoxic activity unrelated to the cell cycle
26
Examples of cell cycle specific drugs?
DNA synthesis inhibitors and mitotic inhibitors
27
Examples of cell cycle non-specific drugs
Alkylating agents and DNA intercalating agents
28
In which cases will cell cycle-specific drugs NOT work?
Cell cycle–specific agents are not active against cells in the resting state (G-0)
29
Alkylating Agents MOA
Interfere with DNA replication to prevent cells from reproducing
30
What is the most severe SE that Alkylating Agents can cause?
acute bone marrow suppression and they are leukemogenic (causing leukemia)
31
Are Alkylating Agents specific or not?
Non-specific
32
Alkylating Agents use
Chronic leukemia Non-Hodgkin’s lymphoma Hodgkin’s lymphoma Multiple myeloma Some cancers of the lung, breast, and ovary
33
Which chemo agent helps empty bone marrow prior to bone marrow transplant to allow new cells to engraft?
Alkylating Agents - cyclophosphamide
34
What is the MC Alkylating Agents used?
clophosphamide
35
What kind of agent is Cyclophosphamide & Ifosafamide?
Alkylating Agents
36
Cyclophosphamide & Ifosafamide SE
Hemorrhagic cystitis Bone marrow depression
37
What can lower the chance of hemorrhagic cystitis d/t Cyclophosphamide & Ifosafamide?
IV injection of Mesna (sodium 2-mercaptothane sulfonate) inactivates the toxic compounds and can minimize hemorrhagic cystitis
38
How can Cyclophosphamide & Ifosafamide be taken?
Orally
39
What kind of agent is Busulfan?
Alkylating Agents
40
Busulfan SE
Dose limiting myelosuppression Pulmonary fibrosis
41
When using Busulfan, what should be monitored?
Baseline, and routine pulmonary function tests (PFTs) are required
42
What type of drugs are Platinum compounds (cisplatin, carboplatin and oxaliplatin)?
Alkylating Agents
43
Platinum compounds (cisplatin, carboplatin and oxaliplatin) SE
Severe, persistent vomiting Nephrotoxicity
44
How long can emesis last after cisplatin administration?
Occurs 1 hour after administration of cisplatin and may continue for as long as 5 days (pretreat w/ Zofran)
45
Antimetabolites MOA
Interfere with DNA and RNA formation - inhibit the normal use of a metabolite by cells
46
What are antimetabolites used to tx?
Used to treat leukemias as well as tumors of the breast, ovary, and the GI tract
47
Which phase do antimetabolites work in?
Cell cycle specific; act in the S phase of the cell cycle
48
What drug class is Folate analogue (methotrexate) part of?
Antimetabolites
49
Folate analogue (methotrexate) MOA
Acts as an antagonist of folate by inhibiting dihydrofolate reductase and reduces DNA, RNA, and protein synthesis
50
Folate analogue (methotrexate) use
Acute leukemia's Non-Hodgkins Rheumatoid arthritis
51
Folate antagonists (methotrexate) SE
Bone marrow toxicities Mucositis Hepatotoxicity
52
What can be administered to prevent Folate antagonists (methotrexate) SE?
leucovorin - usually started 24 hrs after MTX to let the drug do its work
53
Which drugs decrease the elimination of MTX?
Cisplatin, probenecid and NSAIDs decrease elimination leading to toxicity
54
Which drug class is 6-Mercaptopurine (6-MP) in?
Antimetabolite
55
When is 6-Mercaptopurine (6-MP) given?
Given with methotrexate to maintain remission of acute lymphoblastic leukemia (ALL)
56
6-Mercaptopurine (6-MP) SE
Myelosuppression Hepatotoxicity Increased rate of other cancers
57
What drug class is Cytarabine in?
Antimetabolites
58
When is Cytarabine used?
Used in leukemias
59
Cytarabine SE
Allergic conjuntivitis
60
Cytarabine SE
Allergic conjunctivitis
61
Allergic conjunctivitis caused by Cytarabine can be tx with?
Dexamethasone eye drops are required
62
What drug is closely related to cytarabine and is used as a 1st line to tx pancreatic CA?
Gemcitabine
63
What class is 5-Fluorouracil (5-FU) in?
Antimetabolites
64
What is 5-Fluorouracil (5-FU) used for?
BCC + Slow growing solid tumors (colorectal, breast, ovarian, pancreatic, gastric carcinomas)
65
5-Fluorouracil (5-FU) SE
Severe ulceration of the oral and GI mucosa
66
Which drug can minimize 5-FU toxicity?
Leucovorin can be given to minimize toxicity
67
Antitumor Antibiotics MOA
Interfere with DNA by stopping enzymes needed for cell division or by altering the membranes that surround cells
68
Antitumor Abx are cycle nonspecific, what is the one exeption?
Bleomycin
69
Antitumor Antibiotics toxicities
cardiovascular systems, pulmonary
70
Anthracycline abx can cause what type of toxicity?
The anthracycline antibiotics are toxic to the heart, leading to cardiomyopathy
71
What class are Doxorubicin, Daunorubicin, and Idarubicin in?
Antitumor abx
72
When are Doxorubicin, Daunorubicin, and Idarubicin used?
Used in the ABVD regimen for Hodgkins disease
73
Doxorubicin, Daunorubicin, and Idarubicin SE
Irreversible, dose dependent cardiotoxicity
74
What can be given w/ Doxorubicin, Daunorubicin, and Idarubicin to prevent cardiotoxicity?
Dexrazoxane was developed to protect the heart
75
Doxorubicin black box
Cardiomyopathy, secondary malignancy, etc.
76
Bleomycin drug class?
Antitumor abx
77
When is Bleomycin used?
Testicular cancer and a part of ABVD regimen for Hodgkins lymphomas
78
Bleomycin SE
Pulmonary toxicity
79
Bleomycin black box warning
Pulm fibrosis from toxicity
80
Vinca Alkaloids MOA
Inhibit tubulin
81
Which phase of the cell cycle do Vinca Alkaloids act in?
M phase
82
Vinblastine, Vincristine, and Vinorelbine drug class
Vinca Alkaloids
83
Vinblastine, Vincristine, and Vinorelbine SE
Dose limiting neurotoxicity – foot drop syndrome Vinorelbine causes pain at the sight of the tumor
84
Vinca Alkaloids use
Vinblastine is administered with bleomycin and cisplatin for the treatment of metastatic testicular cancer (leukemia and lymphoma)
85
Paclitaxel and Docetaxel drug class
Taxane
86
Paclitaxel and Docetaxel MOA
Stop the microtubules from breaking down - Cancer cells become so clogged with microtubules that they cannot grow and divide
87
Paclitaxel and Docetaxel SE
Serious hypersensitivity Dose limiting neutropenia
88
Paclitaxel and Docetaxel use
Advanced ovarian cancer, breast cancer Also used for other cancers (AIDS-related Kaposi’s sarcoma and lung cancer)
89
Paclitaxel black box
Anaphylaxis can occur
90
Biological Response Modifiers MOA
Stimulate the patient’s immune system to protect the body from foreign substances such as tumor cells
91
Tumor necrosis factor (TNF):
natural substance produced by many cells in response to the presence of tumor cells and infectious agents
92
Monoclonal antibodies
agents that are able to target specific antigens
93
Rituximab is in what drug class?
Monoclonal antibodies
94
Rituximab black box
Fatal infusion rxn
95
Bevacizumab is in what drug class?
Monoclonal antibody
96
Bevacizumab MOA
Antibody to vascular endothelial growth factor (VEGF) which cuts off blood supply to the tumor (angiogenesis inhibitor)
97
When is Bevacizumab used?
First line for colorectal cancer, non-small cell lung cancer, breast cancer
98
Bevacizumab black box
Can cause hemorrhage - GI perforations, surgery healing issues, etc.
99
Cytokines
naturally occurring substances secreted by immune system cells
100
Interferons
proteins produced by the body in response to biological agents such as viruses and tumor cells
101
Interleukins
regulatory substances produced by lymphocytes and monocytes
102
Colony-stimulating factors (CSF):
naturally occurring proteins that regulate the growth and development of blood cells
103
What does G-CSF (granulocyte colony-stimulating factor) do?
G-CSF (granulocyte colony-stimulating factor) increases the number of granulocytes or neutrophils, WBCs that are vital to fighting infection
104
Erythropoietin
naturally produced by the kidneys in response to decreased RBC production or hypoxia
105
Vaccine therapy
based on the idea that tumor-associated antigens are on the cell surface of tumors not found on normal cells
106
Gene therapy
technique in which new genetic material is inserted into a patient’s cell to correct an inborn genetic error or to introduce a new biological function to the cell
107
What drug class is Tamoxifen in?
Selective estrogen receptor modulator
108
When is Tamoxifen used?
prevention of breast cancer in high-risk patients and breast CA
109
Tamoxifen SE
Hot flashes, fluid retention, vaginal bleeding and discharge, thromboembolism Can cause endometrial cancer
110
Raloxifene is better than Tamoxifen because?
lower risk of uterine cancer and thromboembolism
111
Raloxifene drug class
SERM
112
Fulvestrant drug class
Pure estrogen-receptor antagonist
113
Advantages of Fulvestrant?
No endometrial cancer risk and low thromboembolism risk
114
Anastrazole and Letrozole drug class
Aromatase inhibitors
115
Anastrazole and Letrozole use
breast CA in postmenopause
116
Anastrazole and Letrozole SE
Increased risk of fx
117
Do Anastrazole and Letrozole have any increased risk of endometrial CA or thromboembolism?
No
118
Flutamide, Bicalutamide and Nilutamide drug class
Androgen receptor blockers
119
Flutamide, Bicalutamide and Nilutamide use
prostate CA
120
Flutamide, Bicalutamide and Nilutamide SE
gynecomastia and liver injury (black box)
121
Luteinizing hormone–releasing hormone agonists
Cause stimulation of the LHRH receptor that results in decreased output of luteinizing hormone (LH) by the anterior pituitary
122
leuprolide and Goserelin drug class
Luteinizing hormone–releasing hormone agonists
123
How do steroids work in CA therapy?
Glucocorticoids (prednisone, dexamethasone): suppress mitosis in lymphocytes
124
Progestins use
used in breast and endometrial cancer Also used to stimulate appetite in cachectic patients
125
Dexrazoxane and Amifostine are used for what?
Chemoprotective agents

Pharm Exam 3 (7 decks)

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